The results should be interpreted cautiously due to the poor quality of the evidence generic 15 gr differin free shipping skin care doctors. Constipation Drugs Page 69 of 141 Final Report Drug Effectiveness Review Project Likewise generic differin 15gr overnight delivery acne getting worse, no evidence is available to determine the ideal treatment duration of drugs used to treat chronic constipation or when treatments should be switched if patients do not respond. Similarly, we did not find any studies published as full text articles specifically designed to compare the effect of constipation drugs in particular subpopulations. The lack of scientific evidence for drugs used to treat constipation has been pointed out in several 71, 73-75 systematic reviews. Some of these studies focused on interventions not included in this report; others examined the efficacy and safety in populations with occasional constipation. All of them stress the lack of high quality evidence to support the efficacy and safety of most interventions. Nevertheless, the absence of evidence of an effect cannot be interpreted as evidence of no effect. Therefore, it is important that well conducted future studies reliably establish the efficacy of all commonly used medications used for treatment of constipation. Furthermore, the comparative efficacy and effectiveness of first-line over-the-counter treatments and first-line prescription treatments have to be compared. Moreover, it is important to examine whether new second-line treatments, such as lubiprostone, have an additional, clinically significant treatment benefit as well as better tolerability and safety compared with other available interventions. In addition, it is important that these studies will investigate the effects of these interventions on a variety of constipation related symptoms including straining, bloating, and abdominal discomfort as well as on the patients’ overall well-being and quality of life. Finally, future research should more fully assess comprehensive safety and tolerability data, because much of the current literature does not adequately address these issues. This data will provide clinicians with helpful information needed for better selection of appropriate intervention for patients with chronic functional constipation.

Race or Ethnicity We did not find any evidence on differences of efficacy and harms of constipation drugs for the treatment of chronic constipation or constipation associated with IBS based on race or ethnicity generic differin 15 gr with visa acne vulgaris causes. Co-morbidities We did not find any evidence on differences of efficacy and harms of constipation drugs for the treatment of chronic constipation or constipation associated with IBS based on co-morbidities discount 15gr differin visa acne 2008. Constipation Drugs Page 65 of 141 Final Report Drug Effectiveness Review Project Table 31. Evidence profile ofth e generalefficacy and h arm s ofconstipationdrugs forch ronicconstipationand IB S-C insubgroups Evidence Profile:G eneralefficacy and h arm s ofconstipationdrugs forch ronicconstipationand IB S-C insubgroups N o. Evidence profile ofth e com parative efficacy and h arm s ofconstipationdrugs forch ronicconstipation and IB S-C insubgroups Evidence Profile:C om parative efficacy and h arm s ofconstipationdrugs forch ronicconstipationand IB S-C insubgroups N o. Multiple drugs are commonly used to treat these conditions. Many of these drugs are available over the counter and have been available for decades. Despite the high 2, 70 prevalence and the enormous socioeconomic burden associated with these conditions, results of our review highlight that for most treatments, objective evidence from well-conducted studies on efficacy and safety is largely missing. For medications that are considered first-line treatments such as bulking agents or stool softeners, solid evidence is missing or of questionable methodological quality. Even for drugs that are considered first- line prescription medications such as osmotic laxatives, the evidence is sparse and fraught with severe methodological problems. Although we revised our eligibility criteria while conducting this report to include any controlled prospective study, regardless of design, we could not find any studies on the efficacy and safety of docusate calcium, docusate sodium, and lactulose for the treatment of chronic constipation or IBS-C. A systematic review reported some low-quality evidence supporting the use of lactulose for occasional 71 constipation. However, these findings cannot be extrapolated to populations with chronic constipation or IBS-C. Although multiple studies support the general efficacy of PEG 3350 for the treatment of chronic constipation in adults and children, most of them are short-term (i. The general safety evidence from three RCTs (1 fair and 2 poor quality) suggests PEG 3350 is well tolerated with only minor adverse events (nausea, gas, cramps, and diarrhea).